Provider Demographics
NPI:1710424080
Name:ALLEN, AMY ELIZABETH VITALI (PHD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH VITALI
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BAY SPRING AVE UNIT B5
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1386
Mailing Address - Country:US
Mailing Address - Phone:401-294-0451
Mailing Address - Fax:401-294-0461
Practice Address - Street 1:60 BAY SPRING AVE UNIT B5
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-1386
Practice Address - Country:US
Practice Address - Phone:401-294-0451
Practice Address - Fax:401-294-0461
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042888A103T00000X
RIPS01820103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist